Tag Archives: WASH nutrition integration

Focus on WASH & Nutrition: WASHplus Weekly, Sept 5, 2014

Issue 160 | Sept 5, 2014 | Focus on WASH & Nutrition

This issue contains some of the most recent studies on stunting, open defecation, nutritional interventions, and other WASH and nutrition issues. Recent reports from the World Bank Water and Sanitation Program discuss the impacts of improved sanitation on child growth in Vietnam and Lao PDR. Training materials include the new Global Handwashing Day guide from the Global Public-Private Partnership on Handwashing and a WASHplus infographic on tippy taps.

BLOG POSTS WASHPlus_HTMLbanner_weekly_600x159

Left, Right, and Toilets. Ideas for India, Aug 2014. D Spears. (Link)
Eliminating open defecation in India is a policy priority. This column contends that successful strategies for reducing open defecation may not fit policy stereotypes of the left or the right. While rural sanitation policy in states where this practice is most concentrated has been focused on latrine construction, promotion of latrine use is what will make a difference.

What Do Toilets Have To Do with Nutrition? More Than You Might Think. IFPRI Blog, July 2014. L Haddad. (Link)
A new working paper from the Institute of Development Studies has looked at data from 116 low- and middle-income countries from 1970 to 2012. It found that access to safe water (20 percent) and improved sanitation (15 percent) explained 35 percent of the variation in stunting rates across countries and time periods. This reflects two things: the fact that water and sanitation are strongly linked to stunting reduction, and that both water and sanitation coverage have increased strongly in the past four decades.


The Effect of India’s Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled TrialPLoS Medicine, Aug 2014. R Sumeet. (Link)
The objective of this study is to measure the effect of the Total Sanitation Campaign implemented with capacity building support from The World Bank’s Water and Sanitation Program in Madhya Pradesh on availability of individual household latrines (IHLs), defecation behaviors, and child health (diarrhea, highly credible gastrointestinal illness [HCGI], parasitic infections, anemia, and growth). The intervention led to modest increases in availability of IHLs and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes. The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs.

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WASH, Nutrition and Early Childhood Development: New Evidence in ECD and Findings from the Field

Presenters for this June 25, 2014 webinar:

  • Jenny Orgle, Program Director for the Nutrition at the Center Program at CARE USA, will talk about “Addressing Environmental Enteropathy in CARE’s Nutrition at the Center Program.”
  • Maureen Black, Ph.D., Professor, Department of Pediatrics, University of Maryland School of Medicine, will talk about “New Evidence Linking Nutrition and Early Child Development” and its connection to WASH.
  • Moderated by Helen Petach, USAID, Bureau for Global Health, Office of Health Infectious Diseases and Nutrition

Download/view the presentation slides

WASHplus – WASH/Nutrition Literature Update – March 2014

WASH/Nutrition Literature Update – March 2014

The March 2014 literature update includes details on an upcoming USAID-sponsored WASH nutrition presentation on April 1, 2014, and the March 2014 issue of USAID’s Global Waters magazine with descriptions of USAID WASH and nutrition efforts in Liberia and other countries. Other resources include a 2014 WHO report on childhood stunting, an award winning poster on food hygiene, an enteropathy study in Zimbabwe, and other resources.


April 1, 2014 – Integrating WASH and Nutrition: Current Approaches, Lessons Learned, and Considerations for Future Programming, a presentation by Francis Ngure, Water and Sanitation Program.  Date: Tuesday, April 1, 2014 | Time:  3-4:30 pm | Place: USAID, Room 4.08 E/F, Ronald Reagan Bldg. (RSVP/additional info)
You are invited to a presentation on current strategic and operational approaches linking WASH and nutrition programming based on an investigation conducted by the World Bank Water and Sanitation Program. The session will include preliminary findings and lessons learned from field examples that will inform future programming.


WASH Benefits Study/Bangladesh & Kenya – (Website)
The WASH Benefits Study will provide rigorous evidence on the health and developmental benefits of water quality, sanitation, hand washing, and nutritional interventions during the first years of life. The study includes two cluster-randomized controlled trials to measure the impact of intervention among newborn infants in rural Bangladesh and Kenya. Both will be large in scope and measure primary outcomes after two years of intervention.

Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.  PLoS One, Feb 2014. A Prendergas. (Link)
Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low-grade chronic inflammation may impair infant growth.

Could Poor Sanitation Begin Stunting Children in Utero? 2014. D Spears. (Blog post)
Evidence is building up that enteropathy may matter a great deal.  Andrew Prendergast and nine coauthors published a new paper in PLoS One: “Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.”  They collected data on about 14,000 infants at periodic intervals in their first 18 months of life. They ended up with a sample of 101 stunted infants—meaning too short—and 101 non-stunted infants in order to have a healthy comparison group. The paper is important because it speaks to the hypothesis of enteropathy as a determinant of stunting among poor children who grow up exposed to intestinal disease.

Water, Sanitation, and the Prevention of Stunting:  An Holistic View of Why Food Isn’t Enough, 2014. J Griffiths. (Presentation)
Poor populations will likely eat aflatoxins in foods; many will have environmental  enteropathy and live without good water or sanitation. Lacking WASH and barriers to fecal contamination, they will have a different spectrum of gut bacteria than people with good WASH.

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Jan 2014 – WASH/Nutrition Literature Updates

WASH/Nutrition Literature Update – January 2014

This update contains recent studies and reports on WASH and nutrition issues plus updates on new publications and resources from members of the USAID Community of Practice on WASH and Nutrition. Please contact WASHplus if you have new publications or upcoming events you would like to feature in the February 2014 update. Most of the studies below can also be found on the WASH/Nutrition Library at: http://blogs.washplus.org/washnutrition.

UPDATES FROM COP MEMBERS – New Publications, Upcoming Events, etc.

Alive & Thrive – Ensuring Adequate Nutrient IntakeInsight, Issue 7, 2013.  (Link)
This issue examines why infants require a much higher quality diet than other members of the household, identifies nutrient gaps in typical complementary food diets, and describes strategies for achieving adequate nutrient intake among children 6-24 months old.

FANTA III – Nutrition Assessment, Counseling, and Support (NACS): A User’s Guide, 2013. (Link)
The NACS User’s Guide is a series of modules that provide program managers and implementers with a package of essential information and resources. These modules are living documents and will be updated as appropriate when new evidence, guidelines, or field experience emerges.

London School of Hygiene & Tropical Medicine (LSHTM) – Water, Sanitation and Hygiene (WASH), Nutrition and Infection: Learning Module Update(Link)
The latest evidence from a Cochrane systematic review found a small but significant improvement in the growth of children under the age of 5 who have access to clean water and soap. Analysis of the data from 14 studies conducted in low and middle income countries suggested that interventions to improve the quality of the water in the household and provide soap resulted in an average 0.5 cm increased height growth in children under the age of 5.

USAID SPRING Project – The Nigeria Community and Facility Infant and Young Child Feeding Package, 2013. (Link)
This Infant and Young Child Feeding Package is a necessary tool to ensure uniform training and information sharing throughout Nigeria.


USAID DRAFT Agency-wide Nutrition Strategy [public comment sought], December, 2013. (Link)
A technical working group, comprising individuals across USAID, has developed a draft nutrition strategy and is seeking public comment.

Cyclosporiasis: An Emerging Potential Threat for Water Contamination. Water and Health 2014. H Ahmad. (Abstract)
Cyclospora cayetanensis is an emerging protozoan parasite that causes small intestine gastroenteritis. There is apparently a worldwide distribution, including regions of endemicity, for example, in Nepal, Haiti, and Peru. Due to the lack of a quantification technique, there is limited information on the prevalence of Cyclospora in water environments, necessitating the need for further research on pathways and transmission dynamics and encouraging innovative research in water treatment for improving sanitation and public health.

Public Health and Social Benefits of At-House Water Supplies, 2013. (Link)
B Evans et al.
The headline conclusion from this research is that at-home water supply has significant, measurable benefits when compared with shared water supply outside the home provided that the service is reliable enough to ensure access to adequate quantities of water when required. Reliable at-home water supply results in higher volumes of water consumption, greater practice of key hygiene behaviors, a reduction in musculoskeletal impacts associated with carrying water from outside the home, and improved water quality.

Sanitation and Externalities: Evidence from Early Childhood Health in Rural India, 2014. The World Bank. (Link)
This paper examines two sources of benefits related to sanitation infrastructure access on early childhood health: a direct benefit a household receives when moving from open to fixed-point defecation or from unimproved sanitation to improved sanitation, and an external benefit (externality) produced by the neighborhood’s access to sanitation infrastructure.

Social Protection and Resilient Food Systems: The Role of Cash Transfers, 2013. Overseas Development Institute. (Link)
If linked to education and awareness-raising, cash transfer programs can improve water and sanitation hygiene practices.

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December 2013 WASH/Nutrition Literature Update

Below are updates on news and events from members of the USAID Community of Practice (COP) on WASH and Nutrition and links to recent studies and reports added to the WASH/Nutrition Library. Please send an email if you have a recent publication or an upcoming event that we can feature in the update. The aim is to send these out every 1 to 2 months.


Growing Tall and Smart with Toilets, 2013. Water and Sanitation Program. (Link)
The research in Cambodia found that open defecation not only affects one’s own health, but it also affects the health of one’s neighbors. The extent of open defecation in a community is more important for a child’s development than whether the child’s household itself openly defecates.

Integrating WASH into NTD Programs: A Desk Review, 2013. WASHplus. (Link)
Soil-transmitted helminthes, schistosomiasis, and trachoma are all clearly linked to inadequate sanitation, contaminated food and water, and poor hygiene, providing an opportunity for water, sanitation, and hygiene related approaches to help change behavior and the environment.

Research Priorities for the Environment, Agriculture and Infectious Diseases of Poverty, 2013. WHO. (Link)
This report provides an evaluation of challenges presented by interactions between environment, agriculture and infectious diseases of public health importance. It explores the benefits and limitations of a more systems-based approach to conceptualizing and investigating this problem.

Sanitation Combinations: Water, Sanitation, Hygiene, and Nutrition in Kenya, 2013. G Christensen. (Link)
This research provides evidence that demand for health is highly income elastic, and easy habit formation is essential for high uptake of health interventions.


Determinants of Moderate-to-Severe Anaemia Among Women of Reproductive Age in Tanzania: Analysis of Data from the 2010 Tanzania Demographic and Health Survey.Trop Med Intl Health, Dec 2013. C Wilunda. (Abstract)
Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups.

Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene PromotionAm J Trop Med Hyg, Dec 2013. F Nizame. (Abstract)
Enteric diseases are often caused by poor hygiene and can contribute to stunting. In 50 randomly selected villages in Bangladesh, researchers collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program.